DOCSLIB.ORG

Pakistan Armed Forces Medical Journal

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pakistan Armed Forces Medical Journal ::: Pakistan Armed Forces Medical Journal ::: Issue Year : 2011, Issue Number : 4, Issue Month : December Written By : Habib Ullah Khan, Ishfaq Ahmad, Asim Ishfaq Belongs To : Combined Military Hospital Rawalpindi FREQUENCY OF HYDROCEPHALUS IN POSTOPERATIVE CASES OF MYELOMENINGOCELE. NEED OF VENTRICULOPERITONEAL SHUNT? Abstract Objectives: To assess the frequency of hydrocephalus in postoperative cases of myelomeningocele and the need of ventriculoperitoneal shunt placement. Study Design: Descriptive study Place and Duration: CMH Rawalpindi from Sep 2008 to Nov 2009. Subjects and Methods: Forty patients of either sex with myelomeningocele were included. These patients did not have hydrocephalus at the time of presentation. They were operated upon for myelomeningocele. Postoperative follow up was carried out at 1, 2 and 3 months to look for the development of hydrocephalus. Data was analyzed using SPSS version 17. Results: Out of forty patients 22 (55%) were males and 18 (45%) were females. The age ranged from newborn to 10 months. Thirty five (87.5%) patients had lumbosacral myelomeningocele, 2 (5%) patients thoracic, 2(5%) patients cervical while one patient (2.5%) presented with both cervical and lumbosacral myelomeningocele. Postoperatively 21 (52.5%) patients developed hydrocephalus which were subsequently confirmed on CT scan head and were then subjected to ventriculoperitoneal shunting. Conclusion: High frequency of hydrocephalus was observed in postoperative cases of myelomeningocele and patients presenting with one entity must be looked for the other. Postoperative cases of myelomeningocele should be regularly followed for the evidence of hydrocephalus. Article INTRODUCTION The goal in neurosurgery when treating children with predominantly myelomeningo-cele is to maintain stable neurological functioning throughout the life time of the affected patient. Unfortunately, few long-term outcome studies are available in this regard and often treatment relies more heavily upon the experience of senior practitioners1. Myelomen-inocele is a complex congenital spinal anomaly that causes varying degrees of spinal cord malformation, or myelodysplasia. It is commonly referred to as spina bifida and is classified as a defect of the neural tube. The majority of babies with operated myelomeningocele often have associated hydrocephalus. Management of the later can be one of the most trying problems in this patient population. Cerebrospinal fluid (CSF) diversion is required for the remainder of their lives. VP shunt is preferred over other methods because of the ease in diagnosing a subsequent malfunction compared with other traditional methods like third ventriculostomy2. PATIENTS AND METHODS This was a descriptive study carried out in the department of neurosurgery at Combined Military Hospital Rawalpindi from September 2008 to Nov 2009. Forty patients of either sex with myelomeningocele were recruited. The absence/ presence of hydrocephalus was confirmed by clinical evaluation. Neurological evaluation, head circumference measurement was performed prior to myelomeningocele surgery in all patients. Patients having symptoms and signs of raised intracranial pressure were excluded. The patients who did not have symptoms or signs of intracranial hypertension on presentation were subjected to myelomeningocele repair alone and were then followed up clinically with neurological evaluation and head size measurement at 4 weeks, 2 months and 3 months to look for the development of hydrocephalus. CT scan head was done in those patients found to have signs and symptoms of raised intracranial pressure like vomiting, irritability, drowsiness, bulging fontanella, sunset sign, progressive enlarging head and bradycardia. Inclusion criteria · All patients presenting with myelomeningocele with no clinical and radiological evidence of hydrocephalus · Age less than 10 months. Exclusion criteria · Patients with myelomeningocele having concomitant hydrocephalus · Previously operated for myelomeningocele. · Age more than 10 months. Data analysis All the data collected through the proforma was entered into the statistical package for social sciences (SPSS) version 17 and analyzed through its statistical package. Mean and standard deviation was used for quantitative data like age while frequency and percentage were calculated for qualitative data like gender and post op complications. RESULTS Out of forty patients, 22 (55 %) were males and 18 (45%) were females. The age ranged from newborn to 10 months. The mean age was 4.63 ± 2.547 months. Thirty five (87.5%) patients had lumbosacral myelomeningocele, two (5%) patients thoracic, two (5 %) patients cervical while one(2.5%) patient presented with both cervical and lumbosacral meningocele (Fig 2). http://www.pafmj.org/showdetails.php?id=527&t=o (1 of 3)4/10/2012 12:27:24 PM ::: Pakistan Armed Forces Medical Journal ::: Three (7.5%) patients had CSF leak postoperatively which were corrected by re- do surgery and closure of the leakage site. Two (5%) patients developed post op superficial wound infection which settled down with intravenous antibiotics and repeated dressings (Table http://www.pafmj.org/showdetails.php?id=527&t=o (2 of 3)4/10/2012 12:27:24 PM ::: Pakistan Armed Forces Medical Journal ::: 1). Patients were subjected to measurements of head circumference and evaluated for signs and symptoms of raised intracranial pressure like vomiting, drowsiness, bulging fontanella and sunset signs at one, two and three months post operatively. On confirmation of raised intra cranial pressure, they were subjected to ventriculoperitoneal shunting to relieve hydrocephalus. In our study, at 4 weeks, nine (22.5%) patients had increasing head circumference (OFC) above the normal range but only 5 patients developed hydrocephalus. At 2 months, OFC had increased in twenty three patients but only twelve patients were subjected to ventriculoperitoneal shunting. At 3 months, twelve patients had increasing head circumference but only four patients were operated for VP shunt. At the end of 3 months total of 21 patients underwent VP shunt, the frequency reaching 52.5% (Table 2). At the end of 4 weeks the frequency was 12.5%, at 2 months it was 42.5% and at 3 months it was 52.5%. Postoperatively the development of intracranial hypertension was maximal between 4 weeks and 2 months. Hydrocephalus was noted more frequently and earlier in those cases found to have larger myelomeningocele(> 5cm diameter) and more rostral lesions(upper dorsal and cervical). DISCUSSION Third world countries are facing many problems, socioeconomic, cultural, educational and nutritional that result in congenital anomalies of central nervous system like neural tube defects (NTD) more frequently than developed countries3-7. The rate of shunt placement in some of the largest series of in utero repair of myelomeningocele published in 2003-2004 was 54%, which is significantly lower than shunt placement rate in patients treated postnatally 63-91%8. A study carried out at Balabhai Nanavati hospital Mumbai India between 2000 and 2007 ended up with shunt insertion rate of 56.52% which is slightly more than our study of 52.5% because of the fact that we included only those patients who were not having hydrocephalus at the time of presentation. A retrospective study carried out at the department of neurosurgery Jinnah postgraduate medical centre Karachi included 415 children presenting with myelomeningocele. In this study 88% children showed evidence of hydrocephalus at the time of presentation and all were treated with ventriculoperitoneal shunt insertion3. The prevelance of myelomeningocele is high in the third world countries while it has declined in the developed countries due to antenatal folate supplementation and pregnancy termination9. In most of the children with myelomeningocele, hydrocephalus is not present at birth but develops in early neonatal period10. In some studies the proportion of patients requiring VP shunt has reached 80 to 90%11,13. Hydrocephalus is present in 80% of children with myelomeningocele and relates to any of the described variants of the sylvian aqueduct as well as chiari malformation which itself is almost invariably present.The larger and more rostral the lesion, the greater the likelihood, and converse applies, so that an infant with small sacral lesions have a 50% risk. The myelomeningocele sac may act as a reservoir for the CSF, which then is ablated at the time of repair causing postoperative hydrocephalus12. The optimal treatment of children presenting with myelomeningocele require specialized care to prevent, monitor and treat a variety of potential complications that can affect function, quality of life and survival13. CONCLUSION Hydrocephalus has emerged as a significant post operative sequel in operated patients of myelomeningocele. In any operated patient with post surgical increase in occipitofrontal circumference, hydrocephalus manifests with vomiting, drowsiness, bulging fontanella and sunset signs. This necessitates the placement of a ventriculoperitoneal shunt. Reference 1. Bowman RM, McLone DG. Dev Disabil Res Rev. 2010;16(1):82-7. Neurosurgical management of spina bifida: research issues. 2. Marlin AE. Neurosurg Focus. 2004 Feb 15;16(2):E4. Management of hydrocephalus in the patient with myelomeningocele: an argument against third ventriculostomy. 3. A Sattar M. Hashim, S Ahmad, R jooma. Management of myelomeningocele. Journal of surgery Pakistan( international) 13(1) January- march 2008. 4. Humphrey RP. Spinal
Load more

Recommended publications
  • Pakistan Military Ethnic Balance in the Armed Forces and Problems of Federalism
    MANEKSHAW PAPER No. 39, 2013 Pakistan Military Ethnic Balance in the Armed Forces and Problems of Federalism Dr Ayesha Siddiqa D W LAN ARFA OR RE F S E T R U T D N IE E S C CLAWS VI CT N OR ISIO Y THROUGH V KNOWLEDGE WORLD Centre for Land Warfare Studies KW Publishers Pvt Ltd New Delhi New Delhi Editorial Team Editor-in-Chief : Maj Gen Dhruv C Katoch SM, VSM (Retd) Managing Editor : Ms Avantika Lal D W LAN ARFA OR RE F S E T R U T D N IE E S C CLAWS VI CT N OR ISIO Y THROUGH V Centre for Land Warfare Studies RPSO Complex, Parade Road, Delhi Cantt, New Delhi 110010 Phone: +91.11.25691308 Fax: +91.11.25692347 email: [email protected] website: www.claws.in The Centre for Land Warfare Studies (CLAWS), New Delhi, is an autonomous think tank dealing with national security and conceptual aspects of land warfare, including conventional and sub-conventional conflicts and terrorism. CLAWS conducts research that is futuristic in outlook and policy-oriented in approach. © 2013, Centre for Land Warfare Studies (CLAWS), New Delhi Disclaimer: The contents of this paper are based on the analysis of materials accessed from open sources and are the personal views of the author. The contents, therefore, may not be quoted or cited as representing the views or policy of the Government of India, or Integrated Headquarters of MoD (Army), or the Centre for Land Warfare Studies. KNOWLEDGE WORLD www.kwpub.com Published in India by Kalpana Shukla KW Publishers Pvt Ltd 4676/21, First Floor, Ansari Road, Daryaganj, New Delhi 110002 Phone: +91 11 23263498 / 43528107 email: [email protected] l www.kwpub.com Contents 1.
    [Show full text]
  • EASO Country of Origin Information Report Pakistan Security Situation
    European Asylum Support Office EASO Country of Origin Information Report Pakistan Security Situation October 2018 SUPPORT IS OUR MISSION European Asylum Support Office EASO Country of Origin Information Report Pakistan Security Situation October 2018 More information on the European Union is available on the Internet (http://europa.eu). ISBN: 978-92-9476-319-8 doi: 10.2847/639900 © European Asylum Support Office 2018 Reproduction is authorised, provided the source is acknowledged, unless otherwise stated. For third-party materials reproduced in this publication, reference is made to the copyrights statements of the respective third parties. Cover photo: FATA Faces FATA Voices, © FATA Reforms, url, CC BY-NC-SA 2.0 Neither EASO nor any person acting on its behalf may be held responsible for the use which may be made of the information contained herein. EASO COI REPORT PAKISTAN: SECURITY SITUATION — 3 Acknowledgements EASO would like to acknowledge the Belgian Center for Documentation and Research (Cedoca) in the Office of the Commissioner General for Refugees and Stateless Persons, as the drafter of this report. Furthermore, the following national asylum and migration departments have contributed by reviewing the report: The Netherlands, Immigration and Naturalization Service, Office for Country Information and Language Analysis Hungary, Office of Immigration and Nationality, Immigration and Asylum Office Documentation Centre Slovakia, Migration Office, Department of Documentation and Foreign Cooperation Sweden, Migration Agency, Lifos
    [Show full text]
  • O Rigin Al a Rticle
    International Journal of Political Science, Law and International Relations (IJPSLIR) ISSN (P): 2278-8832; ISSN (E): 2278-8840 Vol. 10, Issue 1, Jun 2020, 55–64 © TJPRC Pvt. Ltd. PAKISTAN’S COUNTER TERRORISM STRATEGY: AN OVERVIEW AND ASSESSMENT OF MAJOR MILITARY OPERATIONS (2002-2020) YUMNA CHAUDHRY 1, ZAHEER ABBAS 2 & LIU YUAN 3 1Research Scholar, School of Political Science and Public Administration, Shandong University, Qingdao, China 2Postdoctoral Fellow, School of Political Science and Public Administration, Shandong University, Qingdao, China 3Professor, School of Political Science and Public Administration, Shandong University, Qingdao, China ABSTRACT In the aftermath of the 9/11 terrorist attacks, Pakistan joined the global war against terrorism. This decision instigated the homegrown terrorist outfits and resulted in a wave of violence across the country. This article examines the military offensives launched by the Pakistani security forces, in the tribal belt, and across the country, to dismantle extremist and terrorist groups, as a part of Pakistan’s counterterrorism policy. By utilizing the official and unofficial sources, it seeks to link the military offensives and their efficacy in uprooting terrorism in Pakistan. This article offers an overview and assessment of the military operations and underlines the significant factors that have severely impeded an effective formulation and implementation of Pakistan’s counterterrorism policy. Empirically, it finds that despite significant gains Original Article Original made with these offensives in recent years, Pakistan’s war against extremism and terrorism is far from over. It argues that Pakistan direly needs an all-out and holistic counterterrorism strategy to win its fight against terrorism and extremism.
    [Show full text]
  • State-Formation and the Military in Pakistan Reflections on the Armed Forces, Their State and Some of Their Competitors
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by eDoc.VifaPol State-Formation and the Military in Pakistan Reflections on the Armed Forces, their State and some of their Competitors Boris Wilke Arbeitspapier/Working Paper Nr. 2 / 2001 Universität Hamburg - IPW Forschungsstelle Kriege, Research Unit of Wars, Rüstung und Entwicklung Armament and Development Anschrift und Bezugsadresse Universität Hamburg - IPW Forschungsstelle Kriege, Rüstung und Entwicklung Allende-Platz 1 D - 20146 Hamburg Telefon +49-40-42838-3689 Fax +49-40-42838-2460 www.akuf.de ISSN 1432-8283 Contents 1. Introduction 1 2. State and state-formation: concepts and research agendas 6 3. The formation of an “overdeveloped” state 9 3.1. The demand for Pakistan and the historical foundations of state-formation 9 3.2. The formation of the state and its armed forces – war-making 11 3.3. The formation of the state and its armed forces: state-making 14 4. State dynamics: The transformation of an overdeveloped state 20 5. State decay or redeployment of the state? 26 6. Epilogue 30 References 34 1 ”We will always remain comited to the Nations Building.” Road sign of the “Frontier Works Organization1” on the way from Islamabad to Muree 1. Introduction For more than forty years of the last century, the international system as well as the behavior of states was determined to a large extent by the rivalry between two superpowers and their allies. The end of this era stimulated speculation on what would follow. As far as the structure of the international system is concerned, many questions have been discussed under the banner of the “New World Order”, an expression made popular on the occasion of the Second Gulf War by U.
    [Show full text]
  • Pakistan Armed Forces Medical Journal
    ::: Pakistan Armed Forces Medical Journal ::: Issue Year : 2011, Issue Number : 4, Issue Month : December Written By : Syed Khawar Ali (Late), Dilshad Ahmed Khan, Farooq Ahmed Khan Belongs To : Armed Forces Institute of Pathology Rawalpindi DETERMINATION OF GLYCOSYLATED HEMOGLOBIN REFERENCE RANGE IN ADULT POPULATION ATTENDING A MILITARY CARE SET UP IN RAWALPINDI Abstract Objective: To determine the glycosylated hemoglobin reference range in healthy adult population attending a military care setup in Rawalpindi in accordance with National Glycohemoglobin Standardization Program (NGSP) and International Federation of Clinical Chemistry (IFCC) Study Design: Descriptive cross-sectional study Place and Duration of Study: Armed Forces Institute of Pathology Rawalpindi from May - Oct 2010 Subjects and Methods: A total of 254 healthy adults (18-80 years) comprising 169 males and 85 females, were included by non probability consecutive sampling from Rawalpindi. History and clinical examination were carried out. Blood HbA1c was analyzed high performance liquid chromatography on biorad D-10. Data were analyzed by SPSS-17. Results: Total 254 subjects consisting of 169 males and 85 females were recruited from Rawalpindi Pakistan. The reference range of total population was found 4.6–6.56% and 2.69–4.81 mmol/mol in accordance with NGSP and IFCC, respectively. When compared in gender, HbA1c levels were not significantly changed. However, the healthy elderly population had higher HbA1c levels. Reference range for HbA1c based on NGSP in individuals <40 years was found 4.52-6.4% while for individuals aged > 40 years, it was 4.8-6.68%.. Conclusion: The reference ranges for healthy individuals and the recommended values for optimal therapy in diabetic patients have to be revised and adjusted.
    [Show full text]
  • Review Articles
    Open Access Review Article Crisis Management Cell For Monitoring COVID-19 Pak Armed Forces Med J 2020; 70 COVID-19 (2): S628-36 REVIEW ARTICLES CRISIS MANAGEMENT CELL FOR MONITORING COVID-19 SITUATION IN PAKISTAN ARMED FORCES – A CASE STUDY Nausheen Bakht, Salman Saleem*, Shazia Nisar*, Syed Shahid Nafees Zaidi**, Eisha Mansoor***, Syeda Aliza Shahid****, Shamim Irshad, Sana Iqbal, Nazish Khan Armed Forces Post Graduate Medical Institute/National University of Medical Sciences (NUMS) Rawalpindi Pakistan, *Pak Emirates Military Hospital/National University of Medical Sciences (NUMS) Rawalpindi Pakistan, **Armed Forces Institute of Cardiology/National University of Medical Sciences (NUMS) Rawalpindi Pakistan, ***Army Medical College/National University of Medical Sciences (NUMS) Rawalpindi Pakistan, ****Combined Military Hospital Lahore Medical College/National University of Medical Sciences (NUMS) Rawalpindi Pakistan ABSTRACT „Reporting and monitoring systems cannot be hurriedly cobbled at the first sign of an impending emergency‟. Crisis Management Cell was established on 29 January 2020 as part of the Medical Directorate COVID-19 response strategy with a mandate to act as a data collection point & repository for relevant decision making and policy formulation. Since its inception, it has proved its mettle by enabling a paradigm shift from an existing traditional passive surveillance system to an active, near-real-time data collection and dissemination arrangement. This transition involved a whole-hearted commitment of top brass and a herculean effort on part of Crisis Management Cell. Its functioning non-stop, 24/7 on war-like footings for attaining assigned objectives has been highly appreciated by all rank and file. By writing this case study, authors intend to share the work done by Crisis Management Cell for nearly seven months.
    [Show full text]
  • Counterinsurgency in Pakistan
    THE ARTS This PDF document was made available CHILD POLICY from www.rand.org as a public service of CIVIL JUSTICE the RAND Corporation. EDUCATION ENERGY AND ENVIRONMENT Jump down to document6 HEALTH AND HEALTH CARE INTERNATIONAL AFFAIRS The RAND Corporation is a nonprofit NATIONAL SECURITY institution that helps improve policy and POPULATION AND AGING PUBLIC SAFETY decisionmaking through research and SCIENCE AND TECHNOLOGY analysis. SUBSTANCE ABUSE TERRORISM AND HOMELAND SECURITY TRANSPORTATION AND Support RAND INFRASTRUCTURE Purchase this document WORKFORCE AND WORKPLACE Browse Books & Publications Make a charitable contribution For More Information Visit RAND at www.rand.org Explore the RAND National Security Research Division View document details Limited Electronic Distribution Rights This document and trademark(s) contained herein are protected by law as indicated in a notice appearing later in this work. This electronic representation of RAND intellectual property is provided for non-commercial use only. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see RAND Permissions. This product is part of the RAND Corporation monograph series. RAND monographs present major research findings that address the challenges facing the public and private sectors. All RAND mono- graphs undergo rigorous peer review to ensure high standards for research quality and objectivity. Counterinsurgency in Pakistan Seth G. Jones, C. Christine Fair NATIONAL SECURITY RESEARCH DIVISION Project supported by a RAND Investment in People and Ideas This monograph results from the RAND Corporation’s Investment in People and Ideas program.
    [Show full text]
  • Revised Draft UN Civil Military Guidelines for Complex Emergency
    Draft Guidelines for Civil-Military Coordination in Pakistan March 2010 2 Draft Guidelines for Civil-Military Coordination in Pakistan ACRONYMS .............................................................................................................................. 3 EXECUTIVE SUMMARY ........................................................................................................... 4 PART I ....................................................................................................................................... 6 A. Introduction ....................................................................................................................... 6 Purpose ............................................................................................................................. 6 Scope ................................................................................................................................ 6 Applicability ....................................................................................................................... 6 Contents and structure of the document ........................................................................... 7 Sources ............................................................................................................................. 7 B. Key Actors for Emergency Responses in Pakistan .......................................................... 8 Government and Military Actors ......................................................................................
    [Show full text]
  • Operation Radd-Ul-Fasaad: Evaluating the Gains & Gauging the Challenges Ahead
    Operation Radd-ul-Fasaad: Evaluating the gains & gauging the challenges ahead Hamdan Khan and Hamayoun Khan Islamabad Policy Institute, Pakistan Operation Radd-ul-Fasaad Summary As part of nearly two decades old war on terror, Pakistan launched Operation Radd-ul- Fasaad in 2017 to consolidate the gains made in the long campaign. This operation was regarded as the most comprehensive and encompassing of all the previously launched operations due to its inclusive nature. It included both hard as well as soft elements of the strategy for countering the menace of terrorism, which had haunted the country for nearly two decades. This operation yielded a set of mixed results wherein the military took lead in kinetic aspect while the civilian government and its institutions lagged far behind in their area of responsibility. The execution of consensus based NAP, which was categorized as the hallmark of this operation, still awaits implementation in its full essence with some of its points either left entirely untouched or given appallingly less consideration. Recently government has shown some willingness and resolve to bridge the gaps noted in the implementation of NAP, but as they say proof of the pudding is in the eating, only time will tell if those shortcomings are addressed. 1. Introduction: Pakistan’s fight with extremism is as old as its inception. The country has been struggling to tackle extremist shade of religious and ethnic fault lines existing within its society. For years, this nuisance posed serious challenge for the state either in one or the other form. However, this problem aggravated sharply after US invasion of Afghanistan in 2001 and the State of Pakistan entered into a direct confrontation with forces of violent extremism and terrorism.
    [Show full text]
  • ISI and the Pakistani Army by Robert B
    No. 247 Strategic Forum October 2009 Institute for National Strategic Studies National Defense University http://www.ndu.edu/inss Radicalization by Choice: ISI and the Pakistani Army by Robert B. Oakley with Franz-Stefan Gady Key Points and its intelligence unit, the Inter-Services process whenever it threatened to run counter Intelligence Directorate (ISI), remain the to national interest and security as defined by most important elements in determining the army leadership.2 The Pakistani army and the Inter-Services Pakistan’s future. The army establishment is This tradition started with General Ayub Intelligence Directorate remain essential for the security and stability of Pakistan. Both organiza- the glue that holds this large multi-ethnic, Khan and the military coup he launched in tions have deliberately embraced Islamic radi- nuclear-armed Muslim country together. 1958. The ISI was instrumental in maintain- calism as a means to address the conventional Throughout Pakistan’s history, the army has ing Ayub’s military dictatorship. Subsequently, military gap between Pakistan and India. served as “kingmaker” with decisive influ- the army and civilian political leadership Although there are signs of a shift in ence on political leadership, as guarantor of took turns running the country, but Zulfikar Pakistan’s short-term strategic priorities and stability within the state, and as protector of Ali Bhutto was the only civilian to play a recognition that the challenge of homegrown the nation against external threats. truly dominant role in the 60-year history of Taliban is not just a U.S. problem, India will Pakistan’s armed forces are the eighth Pakistani politics.
    [Show full text]
  • An Introduction to Pakistan's Military
    An Introduction to Pakistan’s Military July 2011 Belfer Center for Science and International Affairs Harvard Kennedy School 79 JFK Street Cambridge, MA 02138 Fax: (617) 495-8963 Email: [email protected] Website: http://belfercenter.org Design and Layout Tim Duffy Copyright 2011 President and Fellows of Harvard College Printed in the United States of America Contents Introduction 4 Pakistan’s Strategic Challenges: Traditional Threats and New Adversaries 8 External Threats, Inconsistent Partners 8 Internal Threats 19 A Short History of Pakistan’s Military 22 Indian Partition, Kashmir, and the Use of Proxies 22 US Military Aid, the First Military Regime, and the 1965 War 23 The 1971 War and a Return to Civilian Rule 24 Islamization, the Mujahideen, and Nuclear Stumbling Blocks 25 A Return to Civilian Rule 26 Musharraf and Kargil 27 The Post-September 11 World 27 Conventional Capabilities 30 Army 30 Air Force 31 Navy 32 Proxies 32 Nuclear Strategy and Security 34 Command and Control 35 Nuclear Doctrine 36 Key Concerns About Pakistan’s Nuclear Program 36 Counterinsurgency 38 Appendices 40 Acronyms 41 Endnotes 42 Introduction Pakistan’s military is a central actor in many of today’s most pressing security challenges, and few institutions face such extreme pressures from such diverse forces. In recent years the military has been asked to simultaneously combat a vicious internal insurgency, suppress international terror- ist groups, and respond to Pakistan’s worst floods in eighty years, all while squaring off against a much larger rival in one of the most strategically complex regions in the world. Pakistan’s armed forces are not only an instrument of the state’s foreign policy, but also the most influential actor in the country’s internal politics.
    [Show full text]
  • Clausewitzian Analysis of Operation Zarb-E-Azb
    Pakistan Social Sciences Review P-ISSN 2664-0422 March 2021, Vol. 5, No. I [314-328] O-ISSN 2664-0430 RESEARCH PAPER War as an Instrument of Political Policy: Clausewitzian Analysis of Operation Zarb-E-Azb Dr. Sardar Muhammad * 1 Dr. Rabia Rustam 2 1. Assistant Professor, Department of Humanities, COMSATS University Islamabad (Abbottabad Campus), Abbottabad, KP, Pakistan 2. Assistant Professor, Department of Humanities, COMSATS University Islamabad (Abbottabad Campus), KP, Pakistan PAPER INFO ABSTRACT Received: The article examines C.V. Clausewitz’s view of War as an February 03, 2021 Accepted: instrument of political policy, and its viability as a model March 01, 2021 criterion to evaluate modern military operations like Operation Online: March 15, 2021 Zarb-e- Azb.The significance of Clausewitz’s theory lies in its Keywords: practicability. Through juxtaposing Clausewitzian views and Clausewitz, Instrument the facts from the field of warthe level of compatibility has been Militants, Operation Zarb-e- traced. The study has provided substantialevidence to conclude Azb that Operation Zarb-e-Azb has been initiated and concluded in *Corresponding Author accordance with Clausewitzian view, and that, it can also be sardarmuhammad2 [email protected] followedas an approach to study and evaluate other similar sardarmuhammad@ cuiatd.edu.pk military operations. Introduction Operation Zarb-e-Azb, a war based on the policy of ensuring peace and economic development in Pakistan seems to be in line with Clausewitz’s view that ‘war is an instrument of policy’. Clausewitztreats policy as representative of all interests of the community (1976, p.607). To protect the people’s life and safeguard their interests from the menace of terrorism, a “violent action for political purposes” (Cambridge Advanced Learner’s Dictionary),the Government of Pakistan as a policy-making organ of the state realized the inevitability of military action.
    [Show full text]